Orthopedic surgeons require many different lengths of fasteners to accommodate all of the different procedures and anatomy that they encounter during surgery. Currently, manufacturers meet the needs of surgeons by supplying them with many different size fasteners that accommodate a range of lengths that the surgeon is likely to require. This means that inventories of fasteners have to be large to offer all the sizes that may be required. Even with large inventories, a surgeon is always forced to choose from the discrete number of sizes available which means he is often not getting the exact length he wants. Too long a fastener length can lead to soft tissue irritation on the protruding end and too short a fastener length can result in poor screw purchase.
Currently, fasteners of different discrete lengths are delivered to the surgeon in the operating room in two alternate modes:                (A.) As part of a “surgical tray” containing surgical appliances (such as plates), fasteners and instruments expected to be needed during surgery. The surgical tray and its contents are sterilized prior to every use in the operating room. Normally the fasteners of many different lengths will be included in a “screw caddy” inside the tray. These caddies typically carry tens of fasteners, of which only a small fraction (5% or less) are used in one particular surgery. The unused fasteners remain in the caddy for further sterilization and use in subsequent surgeries.        (B.) As part of a “pre-sterilized kit” that includes a surgical appliance, a set of disposable instruments and a reduced number of fasteners of different lengths. The proper kit is selected by determining the plate (or other surgical appliance) size and orientation (right or left) using a template. The surgeon will then select and use fasteners of the proper length. The unused fasteners are disposed of at the end of the surgery together with the disposable instruments.        
The disadvantage of the surgical tray mode of delivery is that each tray carries a great number of fasteners of different lengths of which only a few are used in a case. This reflects in a high cost idle inventory, given the relatively high cost of surgical grade fasteners.
On the other hand, the disadvantage of the pre-sterilized kit mode of delivery is that, even with a reduced number of fasteners of different lengths in each kit, the number of fasteners actually used in surgery is still a fraction of the fasteners available and the fact that, at the end of the surgery, the unused fasteners are disposed of as waste.
An additional disadvantage inherent in both modes is that fasteners are provided in discrete lengths, usually in 1 or 2 mm increments, thereby limiting the choice of fasteners to those particular lengths.